Cardiovascular disease (CVD) is the leading cause of death and disability in the United States (US). National data show that African Americans carry an undue burden of this chronic disease, indicating the presence of significant health disparities. Surveillance data also show extensive geographical disparities, wherein Southern states, where a majority of African Americans reside, have the highest age-adjusted rates of morbidity and mortality from heart disease. CVD, like most non-communicable diseases, is multifactorial in nature- determined by biologic, behavioral and environmental factors. While much recent research has focused on the influences of neighborhood characteristics on health and health-related behaviors, few studies have examined their role in predominantly high-risk minority populations like African Americans. And those that have show a lack of clarity and consistency on the role of neighborhood characteristics in health and health-related behaviors. Diet is a significant predictor of CVD and coronary heart disease (CHD) risk and recently, the study of dietary patterns has emerged as a promising area in nutrition research. Dietary interventions have also emphasized the role of dietary patterns in reducing the risk of CVD. However, for nutritional interventions to be effective, they must consider existing dietary patterns followed by their target population. Dietary intake patterns of Africans Americans are significantly different from the general US population. No studies that we are aware have examined the relationship between neighborhood characteristics and dietary patterns and CVD risk in large southern African American populations. In this study, we propose to address this significant gap, by conducting a study to: a) determine the associations between neighborhood characteristics and individual dietary patterns. Neighborhood characteristics examined include neighborhood socio-economic status, availability of and proximity to fast food restaurants, food stores, and parks and recreational facilities, while individual-level dietary patterns include a priori (2005-Healthy Eating Index) and a posteriori (factor analysis derived) dietary patterns; b) determine whether neighborhood characteristics and individual dietary patterns are associated with sub-clinical atherosclerosis; c) describe the relationships between neighborhood characteristics and individual dietary patterns, with: i) incident CHD, ii) hypertension, iii) dyslipidemia, and iv) abdominal subcutaneous and visceral adipose tissue in an NIH-supported, largest single-site, population- based, prospective, observational, all African American cohort, located in Jackson, Mississippi, the Jackson Heart Study. We plan to examine these relationships using neighborhood and dietary data that have been collected at baseline, and outcomes assessed at baseline, 4- and 5- y follow-up of the Jackson Heart Study. We believe that the results of the proposed study will fill a critical gap in knowledge and will help clinicians and policymakers design effective and targeted intervention programs and policy recommendations to prevent the onset and delay the progression of CVD in an under-studied, high-risk minority population. PUBLIC HEALTH RELEVANCE: Cardiovascular disease is the leading cause of morbidity and mortality in United States and affects African Americans disproportionately. It is therefore critical that we have a better understanding of the factors influencing cardiovascular disease risk in African Americans. Neighborhood characteristics and diet are examples of such potentially modifiable factors, and the study of these relationships is likely to guide the development of improved interventions and policy recommendations to ameliorate these health disparities.